Haas Martin, Leko-Mohr Zdenka, Roschger Paul, Kletzmayr Josef, Schwarz Christoph, Mitterbauer Christa, Steininger Rudolf, Grampp Stefan, Klaushofer Klaus, Delling Günter, Oberbauer Rainer
Department of Internal Medicine III, University Vienna, Austria.
Kidney Int. 2003 Mar;63(3):1130-6. doi: 10.1046/j.1523-1755.2003.00816.x.
Bisphosphonates can prevent bone mineral density loss after renal transplantation, but their effect on trabecular mineralization and bone morphology, two key factors of bone stability, remains unknown.
In a 6-month, randomized, placebo-controlled study, 20 kidney transplant recipients received either 4 mg zoledronic acid or placebo twice within 3 months after engraftment. At transplantation and after 6 months, mean trabecular calcium concentration and trabecular morphometry were measured in bone biopsies. Bone mineral density (BMD) of the femoral neck and the lumbar spine were evaluated by dual-energy x-ray absorptiometry, and serum biochemical markers of bone metabolism were determined monthly.
Trabecular calcium content increased significantly in the zoledronic acid group, but remained unchanged in the placebo group. BMD at femoral neck showed no change in the zoledronic acid group, but decreased in the placebo group. BMD of the lumbar spine was increased in the zoledronic acid group without change in the placebo group. High-turnover bone disease resolved similarly in both groups, as evidenced by a significant decrease of eroded bone surface, osteoclast and osteoblast surface. Serologic markers of bone formation and resorption were significantly lower in zoledronic acid-treated patients throughout the study. Kidney transplant function was stable after zoledronic acid therapy.
Our results show that administration of zoledronic acid improves the calcium content of cancellous bone after kidney transplantation. The beneficial effect of bisphosphonate therapy is further evidenced by an increase of lumbar spine BMD, and stabilization of femur BMD.
双膦酸盐可预防肾移植后骨矿物质密度的流失，但其对骨小梁矿化和骨形态（骨稳定性的两个关键因素）的影响尚不清楚。
在一项为期6个月的随机、安慰剂对照研究中，20名肾移植受者在移植后3个月内接受了两次4mg唑来膦酸或安慰剂治疗。在移植时和6个月后，测量骨活检中的平均骨小梁钙浓度和骨小梁形态学指标。通过双能X线吸收法评估股骨颈和腰椎的骨矿物质密度（BMD），并每月测定骨代谢的血清生化标志物。
唑来膦酸组骨小梁钙含量显著增加，而安慰剂组保持不变。唑来膦酸组股骨颈骨密度无变化，而安慰剂组降低。唑来膦酸组腰椎骨密度增加，安慰剂组无变化。两组高转换型骨病的缓解情况相似，骨侵蚀表面、破骨细胞和成骨细胞表面显著减少证明了这一点。在整个研究过程中，唑来膦酸治疗患者的骨形成和骨吸收血清标志物显著降低。唑来膦酸治疗后肾移植功能稳定。
我们的结果表明，给予唑来膦酸可改善肾移植后松质骨的钙含量。腰椎骨密度增加和股骨骨密度稳定进一步证明了双膦酸盐治疗的有益效果。
